{
  "abstract": "Background: Bilateral macronodular adrenocortical disease is a rare cause of ACTH-independent hypercortisolism. Some patients present without typical Cushingoid features, which may lead to delayed diagnosis.\n\nCase Presentation: A 53-year-old woman presented with poorly controlled diabetes and resistant hypertension despite three antihypertensive agents. She lacked typical Cushingoid features. Laboratory evaluation showed elevated 24-hour urinary free cortisol (UFC) (1656.00 μg/24h; normal: 75.00–520.00 μg/24h), absent circadian rhythm, suppressed ACTH (<5 pg/mL), and non-suppression on low-dose dexamethasone suppression test. Contrast-enhanced CT revealed bilateral adrenal multiple nodular lesions (left: 46×35 mm; right: 57×42 mm). A diagnosis of BMAD with ACTH-independent hypercortisolism without classic Cushingoid features was established.\n\nManagement and Outcome: The patient underwent right unilateral adrenalectomy. Postoperatively, glycemic control and blood pressure improved rapidly. At two-year follow-up, cortisol levels remained normal, and both antihypertensive and antidiabetic medications were discontinued without relapse.\n\nConclusion: BMAD can present with isolated metabolic comorbidities without classic CS features. In selected patients with asymmetric BMAD and ACTH-independent hypercortisolism without classic Cushingoid features, unilateral adrenalectomy of the larger gland may represent a reasonable adrenal-sparing option, achieving sustained biochemical and metabolic remission even in the presence of markedly elevated preoperative UFC levels.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Endocrinology, Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University",
    "Department of Pathology, Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University",
    "Department of Pathology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou Normal University",
    "Department of Endocrinology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou Normal University",
    "Huzhou Central Blood Station"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yujia Qiu"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Pengtao Song"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Jianping Yao"
    },
    {
      "affs": [
        4
      ],
      "name": "Le Wang"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Jiyuan Ying"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8aqm8jmarxepn.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1917551",
  "fulltext_url": null,
  "id": "8aqm8jmarxepn",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1917551/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Adrenal and Paraganglionic Tumors"
    ]
  ],
  "openalex": "W7222916245",
  "pdf_url": "https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1917551/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/8aqm8jmarxepn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.3389/fendo.2026.1917551",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1917551/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Adrenal and Paraganglionic Tumors",
      "subfield": "surgery"
    }
  ],
  "title": "Case Report: A case study on bilateral macronodular adrenocortical disease: ACTH-independent hypercortisolism with refractory diabetes and hypertension",
  "title_text": "Case Report: A case study on bilateral macronodular adrenocortical disease: ACTH-independent hypercortisolism with refractory diabetes and hypertension",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:20Z",
  "url": "https://research.draconitic.com/paper/8aqm8jmarxepn",
  "venue": "Frontiers in Endocrinology",
  "versions": []
}